Coppie genitoriali e adolescenti anoressiche: studio delle dinamiche intrapsichiche e intrafamiliari

During the last years the incidence of anorexia nervosa has been an incidence of 4-8 new cases every 100.000 people per year; it represents an important social and health problem. Epidemiological studies point out a preponderance rate of 0,5-3,7% in adolescent and early adult age (12-25 years old) among female population (20 to 1 compared to males) according to the American Psychiatric Association (APA, 2000). Anorexia nervosa is a psychiatric pathology with a complex pathogenesis (Onnis, 2004), in which several socio-cultural, individual and relational psychological factors, and in particular family ones, come into play. Literature shows a variety of theoretical models on the pathogenesis of anorexia nervosa. There is little attention on studying the influence of the quality of couple bonding and marital relationships and their correlation with the children’s eating disorders (Canals, 2009; Espina 2009). The families of patients with eating disorders seem to be part of a "normality" (Laporte 2003), while a "pathology" in the couple dynamics, usually denied and ignored (Cook-Darsenz, 2005) can influence the development of children. The aim of the research project is to investigate the possible influence of the quality of parental and marital relationships on development of Anorexia Nervosa and the possible correlations of couple dynamics with the psychopathology of children’s eating disorders . The experimental group included 42 female gender patients, who entered for the first time our hospital division between 13 - 17 years (mean age 14,6 years old; SD=1,41) with diagnose of the different kinds of anorexia nervosa (subtypes according to DSM-IV-TR) and their parents. The non clinical control group consisted of 42 healthy subjects (mean age 14,5 years old; SD=1.52) and their parents. At the first admission (T0) to the ward or Dh, all patients and parental couples underwent exploratory sessions to investigate different areas related to the relationship of the patient with food and her own body and to the quality of the relationship with her parents. The parents received exploratory sessions to investigate some aspects related to the parental quality and conjugal bond. In addition to this an operator administered to patients a blind test battery (EDI-III, CDI, BFQ-C and FACES), aimed at a clinical evaluation of symptoms and of personality characteristics and family dynamics; the parents were asked to separately fill out DAS, BDI II, BFQ-2 and FACES III, which assesses the dynamics and quality of marital and parental bond. Main factors from the test battery were depressive aspects of mother and father (BDI), the consensus, cohesion and affective expression received of mother (DAS) and friendship and conscientiousness of fathers (BFQ). At BDI scale the mothers appear to have psychopathological aspects relating to cognitive events while fathers seem to have more difficulties in the somatic-affective aspects. Couple dynamics seem to be characterized by an “anti-libidinal” relationship and sexual difficulties and a marked dissatisfaction (78,05%). The dissatisfaction is also associated with the total pathological score of the DAS. In 70,6% of cases the parents have psychopathological traits that affect their parenting skills. The marital relationship seem to link to other aspects of the history and personalities of each member of the couple (in particular aspects of depressive personality, an inability to share various family activities from their husbands and disagreement by the wife in areas such as religion, home management and time spent together with the partner and the difficulty of the couple to express their feelings).The sessions with parents seem important to assess the couple dynamics and the “normal” families. The clinical sample seems to describe a dysfunctional relationship characterized by a rigid and less cohesive, by a conflict of roles and requirements as a pathological defense against the growth of the couples and the daughter. These dynamics appear to have a pathological role in the development of children and to influence the quality of parental roles and the overall welfare of their partners.